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Nursing certifications, matched to the unit you work on

Facts checked against bcen.org, msncb.orgLast checked Nov 4, 2026

A nursing specialty certification is a credential an RN earns by passing a certification board's exam, on top of the license, and keeps by renewing on that board's cycle. Each certification has its own board and its own rules on hours. We cover two so far: the CEN for emergency nurses and the CMSRN for medical-surgical nurses.

Find your exam
On this page
  1. Which exam fits your unit
  2. CEN and CMSRN side by side
  3. Which hours count
  4. Boards and associations are different bodies
  5. Other ER and specialty certifications
  6. Other fields
  7. Sources
  8. Nursing certifications: quick answers

Which exam fits your unit

Start from the unit you work on:

Nursing4 situations · 2 exams

CEN and CMSRN side by side

ExamExam ownerWho can sitQuestionsExam timePassing scoreExam feeWhere you testRenew everyTo renewPass rateSource
CENBCENFree practice testExam infoBCENUnencumbered RN license1753 h99/150$380Test center or online4 years100 contact hours≈51% (2025)as of Nov 4, 2026 · calculated from BCEN's 2025 counts[1] [2] [3] [4] [5] [6] [7] [8] [9]
CMSRNMSNCBFree practice testExam infoMSNCBRN + 2,000 med-surg hours1503 h95 scaled$394Test center or online5 years1,000 hours + 90 contact hours or exam67% (2025)[10] [11] [12] [13] [14] [15] [16]

Each value links to its source under Sources; checked Nov 4, 2026.

Which hours count

Hours matter twice: once to qualify, and again to renew.

  • Emergency, to qualify: no hours at all. BCEN recommends two years in an emergency department but does not check it.
  • Med-surg, to qualify: RN + 2,000 med-surg hours within the past three years. Pediatrics, psych, OB/GYN, OR and ED hours do not count.
  • Emergency, to renew: 100 contact hours per cycle, with floors for clinical and accredited hours; the accredited floor rises on January 1, 2027, and CE approved only by EMS bodies does not count.
  • Med-surg, to renew: med-surg practice hours during the cycle on either route, plus contact hours or a passing exam score; the numbers are on the CMSRN page.

Course card or board certification?

CEN is a certification. TNCC, ENPC, ACLS and PALS are certificate courses, not certifications. A certificate course ends with a card for finishing the training, while a certification comes from a board's proctored exam and lapses unless renewed. An employer may ask for either kind, and one does not stand in for the other.

Boards and associations are different bodies

  • Emergency: BCEN certifies. ENA, the Emergency Nurses Association, is a membership group whose members get a lower fee.
  • Med-surg: MSNCB certifies. AMSN is the membership association tied to it and sets the member price.
  • MEDSURG-BC: ANCC's med-surg credential, a separate exam from a different board. How the two differ: the two med-surg credentials compared.

The membership association sets the discount; the certification board sets the exam, the eligibility rules and the renewal audit.

Other ER and specialty certifications

Emergency nurses also meet TCRN (trauma), CPEN (pediatric emergency) and CFRN (flight); critical care nurses meet CCRN, progressive care nurses PCCN, and operating room nurses CNOR. We have not added these exams yet; each board publishes its own rules.

Other fields

Sources

  1. [1]BCEN: about the CEN exam bcen.org. Checked Nov 4, 2026.
  2. [2]BCEN: CEN FAQs bcen.org. Checked Nov 4, 2026.
  3. [3]BCEN: CEN eligibility bcen.org. Checked Nov 4, 2026.
  4. [4]BCEN Candidate Handbook, 2024 (PDF) bcen.org. Checked Nov 4, 2026.
  5. [5]BCEN blog: Evolving Excellence, Updating the CEN Exam (Feb 10, 2026) bcen.org. Checked Nov 4, 2026.
  6. [6]BCEN: CEN cost bcen.org. Checked Nov 4, 2026.
  7. [7]BCEN: CEN exam delivery bcen.org. Checked Nov 4, 2026.
  8. [8]BCEN: recertify bcen.org. Checked Nov 4, 2026.
  9. [9]BCEN: certification exam statistics (ABSNC disclosure, 2025) bcen.org. Checked Nov 4, 2026.
  10. [10]MSNCB CMSRN Certification Handbook, last updated July 2026 (PDF) msncb.org. Checked Nov 4, 2026.
  11. [11]MSNCB: about MSNCB msncb.org. Checked Nov 4, 2026.
  12. [12]MSNCB: CMSRN certification msncb.org. Checked Nov 4, 2026.
  13. [13]MSNCB: exam processes, scheduling and fees msncb.org. Checked Nov 4, 2026.
  14. [14]MSNCB CMSRN Recertification Handbook, January 2026 (PDF) msncb.org. Checked Nov 4, 2026.
  15. [15]MSNCB: CMSRN recertification msncb.org. Checked Nov 4, 2026.
  16. [16]MSNCB: statistics msncb.org. Checked Nov 4, 2026.

Nursing certifications: quick answers

Does a certification replace the RN license?

No. Every specialty certification here requires a current, unencumbered RN license and lapses separately from it.

Which certification fits a step-down unit?

Neither exam covered here is built for it. Nurses on progressive care or step-down units meet PCCN, which First Attempt has not added yet; before counting step-down hours toward the CMSRN, ask MSNCB.

Can I hold both the CEN and the CMSRN?

Yes. Two boards, two exams and two renewal clocks; the med-surg one still needs its practice hours.